TAILIEUCHUNG - Chapter 133. Tetanus (Part 3)

Vaccine Patients recovering from tetanus should be actively immunized (see below) because immunity is not induced by the small amount of toxin required to produce disease. Additional Measures Like all patients receiving ventilatory support, patients with tetanus require attention to hydration; nutrition; physiotherapy; prophylactic anticoagulation; bowel, bladder, and renal function; decubitus ulcer prevention; and treatment of intercurrent infection. Prevention Active Immunization All partially immunized and unimmunized adults should receive vaccine, as should those recovering from tetanus. The primary series for adults consists of three doses: the first and second doses are given 4–8 weeks apart, and the third dose is given 6–12 months after the. | Chapter 133. Tetanus Part 3 Vaccine Patients recovering from tetanus should be actively immunized see below because immunity is not induced by the small amount of toxin required to produce disease. Additional Measures Like all patients receiving ventilatory support patients with tetanus require attention to hydration nutrition physiotherapy prophylactic anticoagulation bowel bladder and renal function decubitus ulcer prevention and treatment of intercurrent infection. Prevention Active Immunization All partially immunized and unimmunized adults should receive vaccine as should those recovering from tetanus. The primary series for adults consists of three doses the first and second doses are given 4-8 weeks apart and the third dose is given 6-12 months after the second. A booster dose is required every 10 years and may be given at mid-decade ages 35 45 and so on. Combined tetanus and diphtheria toxoid adsorbed Td for adult use rather than single-antigen tetanus toxoid is preferred for persons 7 years of age. Adsorbed vaccine is preferred because it produces more persistent antibody titers than fluid vaccine. Two combined tetanus diphtheria attenuated pertussis vaccines have recently been approved one ADACEL for adults 19-64 years of age and the other BOOSTRIX for adolescents 11-18 years of age. The Advisory Committee on Immunization Practices has recommended a single dose of Tdap ADACEL for adults 19-64 years old who have not received Tdap. Wound Management Proper wound management requires consideration of the need for 1 passive immunization with TIG and 2 active immunization with vaccine Tdap or Td Table 133-1 . The dose of TIG for passive immunization of persons with wounds of average severity 250 units IM produces a protective serum antibody level for at least 4-6 weeks the appropriate dose of TAT an equine-derived product is 3000-6000 units. Vaccine and antibody should be administered at separate sites with separate syringes. Table 133-1 Guide to Tetanus .

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